Adapting to difference: experiences of HIV serodiscordant relationships among Africans in England

Black African people remain a high risk group for HIV in England. Numerous interventions have sought to facilitate HIV status disclosure between sero-discordant couples to encourage transmission risk management. However, few studies have explored if and how communication about HIV is managed past the point of disclosure and throughout the duration of relationships. As part of the Plus One study sixty black African people (39 women and 21 men) living in England who had current or recent experience of an HIV sero-discordant relationship were recruited for interview by community-based agencies. The sample included 44 people with diagnosed HIV, and 16 whose most recent HIV test result was negative. In depth qualitative one-to-one interviews explored: experiences of HIV disclosure or receiving news of one’s partner’s status; communication about HIV between partners, with children, with family members and the broader community; and means of managing HIV practically, and emotionally, within their relationship. While HIV status disclosure is often conceived as a discrete event, participants described ongoing and, in many cases, problematic, communication regarding HIV with their partner. While acknowledging the need to attend to transmission risk, most did not want HIV to become a ‘third person’ in their relationship. Discussion was stifled by a desire to keep children distant from a stigmatised condition and a fear of rejection by family or community members. Not knowing any other sero-discordant couples who were content in their relationship meant it was hard for many to conceptualise their own relationship as viable, and also reduced opportunities for peer support. Adaption to relationship sero-discordance is hampered by a lack of interventions to facilitate communication in relation to HIV, and also an absence of appropriate role models or support from family and community. This silence serves to exacerbate HIV stigma and compromise the perceived viability of sero-discordant relationships.